Specialists at Burjeel Medical City replanted the patient’s arm that was caught in a lathe machine and completely amputated at the forearm level
Abu Dhabi: On September 29, what had been a routine workday turned into a nightmare of a lifetime for 50-year-old Tanveerullah Arif, a resident of Al Dhannah City. While working on a lathe machine, his job for the past 20 years, his left hand was unexpectedly caught in the machine, leaving the upper limb completely amputated at the forearm level. He was rushed to the nearby Burjeel Al Dhannah Hospital for initial care and subsequently transferred to Burjeel Medical City (BMC) in Abu Dhabi for advanced treatment, where a team of specialists worked in close coordination for 10 hours to replant his severed arm with record speed and meticulous precision.
This is a successful replantation of a completely amputated mid-forearm complicated by a severe crush-avulsion injury at the level of the middle of the forearm, a highly complex surgical challenge.
10-hour-long Emergency Replantation
The accident happened around 4:30 pm, and the BMC team received a call from the Al Dhannah Hospital at 5:30 pm. “The emergency and civil defense teams transported the patient by road and reached BMC at 8:15 pm. He was conscious and had lost a lot of blood. Immediately, he was shifted to the operation theater, where anesthetists resuscitated him and gave him a nerve block to prepare for the remaining procedures,” says Dr. Praveen Kumar Arumugam, Specialist, Plastic and Reconstructive Surgery, BMC.
Upon arrival, the team meticulously dissected both the amputated and severed parts to identify muscles, tendons, nerves, arteries, veins, and bones, followed by debridement, a process where the dead, damaged, or contaminated tissues are removed from the wound for better healing.
It’s followed by the fixation of the forearm’s two bones, done using plates and screws. “After that, we did the arterial repair to fix blood flow, a crucial step. In his case, we repaired two arteries and four veins, followed by muscles, tendons, and nerves. During this, we put him on blood thinner to avoid clotting. Once it’s all done, we sutured the skin. After three days, during the second stage, we put a skin graft over the area where the skin was lost. Then, we gave him a cast to ensure the hand is elevated,” explains the doctor, adding that our aim is to give his hand the ability to grasp. In total, six units of blood were transfused during surgery. Anesthetists ensured there was no reperfusion injury, which could lead to heart or kidney failure.
Besides Dr. Praveen, the plastic surgery team included Dr. Arivind Bhamidi, Specialist, Plastic Surgery, and Dr. Michael Rebeiro, Consultant Plastic Surgeon & Director of Plastic Surgery. The orthopedic team included Dr. Ahmed Hammouda, Consultant Orthopedic Surgeon, while anesthesia was handled by Dr. Mahmoud Mohamed, Specialist, Anesthesia, and Dr. Ahmed Omran, Consultant, Anesthesia and Pain Management.
A Microsurgery Demanding Speed and Precision
The patient, who is now able to move his hand a bit, says everything happened so quickly. The machine was running, and he just touched it. “Everything happened so quickly. The machine was running, and I just touched it and it happened. Immediately, the company’s emergency team and firefighters took me to the hospital. I was conscious then,” explains Tanveerullah, whose family in Pakistan comprises a wife and four children. According to the doctors, his young age and healthy body with no comorbidities favored the surgery.
In scenarios like this, the golden window to preserve and reattach the severed part is six hours. Luckily, the patient reached BMC within that time frame with the severed part preserved properly, and the medical team could ensure blood flow. What made it complex was the type of injury – a combination of crush, avulsion, and amputation. “It was not a clean cut like a knife cut, but an avulsion, where the part was torn off, making it even more challenging,” says doctor Arivind Bhamidi, specialist, Plastic Surgery.
During the patient’s transit, the team equipped themselves for the microsurgery, where they connect very small blood vessels under a microscope. It ensured there was no delay in surgical management. “It’s a coordinated effort. We had a sequence of events planned. While one team examined the severed part, the other team checked the forearm. Other sequences were done in tandem. The most challenging part was to get the blood flow quickly and ensure it reached every area of the hand. Because, despite the surgery, if the blood flow isn’t secured, it’s a lost cause,” says the doctor.
Currently, the patient is under recovery, which includes physiotherapy for the movement of fingers, and other procedures if required after follow-up assessments. “The surgery went well, and the doctors here are taking good care of me. I’m feeling much better now. I can even move my hand a little bit again,” concludes the patient.
What to Do in Case of a Crush or Amputation Injury?
1. Call emergency services immediately
Dial the local emergency number (998 in the UAE). Time is critical, especially when a limb is severed or there is heavy bleeding.
2. Control bleeding
Apply firm pressure to the wound using a clean cloth or bandage. If blood soaks through, do not remove the cloth. Instead, place another layer on top.
3. Keep the patient calm and still
Lay the person down and elevate the injured limb if possible to slow bleeding. Avoid giving food or drink.
4. Preserve the severed part properly
Gently rinse the part with clean water without scrubbing. Wrap it in sterile gauze or a clean cloth. Place it in a sealed plastic bag, then put that bag inside another bag or container filled with ice. Do not place the severed part directly on ice or in water.
5. Note the time of injury
Surgeons usually have a golden window of about six hours to attempt successful reattachment. Providing the exact time helps the medical team plan faster.
6. Get to a hospital equipped for microsurgery
Emergency responders or hospital staff can arrange transfer to the nearest emergency hospital.
